Provider Demographics
NPI:1861619140
Name:MILLARD, LAURA H (LCSW-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:MILLARD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W LAKE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2565
Mailing Address - Country:US
Mailing Address - Phone:331-221-1650
Mailing Address - Fax:
Practice Address - Street 1:303 W LAKE ST STE 301
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2565
Practice Address - Country:US
Practice Address - Phone:331-221-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ22112Medicare UPIN
MD492094Medicare ID - Type Unspecified